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IP CAGT ALLOGENEIC SCT CAMGRAFT	

Types:      ONCOLOGY TREATMENT
Synonyms:  FLU, FLUDARA, ALEMTUZUMAB, ALAN, BMT, CAGT, ALLOGENEIC, SCT

Transplant	Repeat 1 time	Cycle length: 90 days	Days -5 through -1	Perform every 1 day x1		Provider Communication
  	ONC PROVIDER COMMUNICATION 64	Interval: Once	Occurrences: --	Comments:	Verify Hep B panel status prior to cycle. Date *** of panel. Result positive/negative/pending/unknown:22867

The required components for the hepatitis B panel includes: Hepatitis B surface antigen (HBsAg), total hepatitis B core antibody (anti-HBc), and hepatitis B antibody (anti-HBs).
			Labs
  	CYTOMEGALOVIRUS ANTIGEN	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC > 1
		  	CYTOMEGALOVIRUS, QUANTITATIVE PCR	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC < 1
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Pre-Medications
  	ondansetron (ZOFRAN) IV 10 mg	Dose: 10 mg	Route: intravenous	every 24 hours for 4 doses	Start: S			Instructions:	Administer 30 minutes prior to treatment on Day -5, -4, -3, -2.			Antiemetics
  	promethazine (PHENERGAN) injection 25 mg	Dose: 25 mg	Route: intravenous	every 4 hours PRN	Start: S				  	ondansetron (ZOFRAN) IV 8 mg	Dose: 8 mg	Route: intravenous	every 8 hours PRN	Start: S+4			Instructions:	Start on Day -1.			Chemotherapy
  	fludarabine (FLUDARA) 30 mg/m2 in sodium chloride 0.9% 100 mL chemo IVPB	Dose: 30 mg/m2	Route: intravenous	every 24 hours over 30 Minutes for 4 doses	Start: S			Instructions:	Day -5, -4, -3, -2.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	FLUDARABINE 50 MG/2 ML INTRAVENOUS SOLUTION	Medications	30 mg/m2	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	QS Base	100 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	QS Base	100 mL	No	Yes			  	alemtuzumab (CAMPATH) 10 mg in sodium chloride 0.9% 100 mL IVPB	Dose: 10 mg	Route: intravenous	every 24 hours over 2 Hours for 4 doses	Start: S			Instructions:	Day -5, -4, -3, -2.	Ingredients:	Name	Type	Dose	Selected	Adds Vol.	ALEMTUZUMAB 30 MG/ML INTRAVENOUS SOLUTION	Medications	10 mg	Main Ingredient	Yes	SODIUM CHLORIDE 0.9 % INTRAVENOUS SOLUTION	Base	100 mL	Yes	Yes	DEXTROSE 5 % IN WATER (D5W) INTRAVENOUS SOLUTION	Base	100 mL	No	Yes				Additional Orders
  	ONC NURSING COMMUNICATION 43	Interval: Daily	Occurrences: --	Comments:	-Monitor VS (temperature, pulse, respirations, and blood pressure) every 15 minutes during Alemtuzumab infusion and for 1 hour following completion.
-Continuous oxygen saturation monitoring during Alemtuzumab infusion and for 1 hour following completion. Keep oxygen at bedside through Day 0.
-STOP INFUSION and CONTACT MD if any of the following occur: shortness of breath, wheezing, chills, severe myalgia, hypotension, rash, or chest pain.
		  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	every 24 hours	Start: S			Instructions:	PREMED FOR ALEMTUZUMAB.		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	every 24 hours	Start: S			Instructions:	PREMED for ALEMTUZUMAB.		  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	every 24 hours				Instructions:	PREMED for ALEMTUZUMAB		  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses						Line Flush
  	sodium chloride 0.9 % flush 20 mL	Dose: 20 mL	Route: intravenous	PRN						Acute Graft Versus Host Prophylaxis
  	tacrolimus (PROGRAF) IVPB 0.02 mg/kg (Ideal)	Dose: 0.02 mg/kg	Route: intravenous	every 24 hours over 24 Hours	Start: S			Instructions:	May cause QTc prolongation.  Use the lesser of IBW or actual body weight (ABW).			Day of Rest
  	ONC NURSING COMMUNICATION 48	Interval: Until discontinued	Occurrences: --	Comments:	Day -1.
				Day 0	Perform every 1 day x1		Labs
  	CYTOMEGALOVIRUS ANTIGEN	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC > 1
		  	CYTOMEGALOVIRUS, QUANTITATIVE PCR	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC < 1
		  	FK506 TACROLIMUS LEVEL, RANDOM	Interval: Once	Occurrences: --	Comments:	Draw on Day 0
			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron (ZOFRAN) IV 10 mg	Dose: 10 mg	Route: intravenous	once for 1 dose	Start: S				  	promethazine (PHENERGAN) injection 25 mg	Dose: 25 mg	Route: intravenous	every 4 hours PRN	Start: S					Pre-Medications
  	acetaminophen (TYLENOL) tablet 650 mg	Dose: 650 mg	Route: oral	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once for 1 dose	Start: S			Instructions:	Premed for TRANSPLANT		  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once for 1 dose				Instructions:	Premed for TRANSPLANT			Transplant Orders
  	ONC NURSING COMMUNICATION 55	Interval: Once	Occurrences: --	Comments:	-Oxygen at bedside during transplantation
-Anaphylaxis precautions at bedside during transplant:
		  	meperidine (DEMEROL) injection (RESTRICTED) 12.5 mg	Dose: 12.5 mg	Route: intravenous	every 15 min PRN for 3 doses				Instructions:	Administer every 15 minutes x 3 doses PRN for each episode of rigors (if rigors persist, call MD).		  	epINEPHrine (ADRENALIN) injection 1 mg/mL 0.3 mg	Dose: 0.3 mg	Route: subcutaneous	once PRN	Start: S	End: S+2			  	diphenhydrAMINE (BENADRYL) injection 25 mg	Dose: 25 mg	Route: intravenous	once PRN	Start: S	End: S+2			  	hydrocortisone sodium succinate (Solu-CORTEF) injection 100 mg	Dose: 100 mg	Route: intravenous	once PRN						Acute Graft Versus Host Prophylaxis
  	tacrolimus (PROGRAF) IVPB 0.02 mg/kg (Ideal)	Dose: 0.02 mg/kg	Route: intravenous	every 24 hours over 24 Hours	Start: S			Instructions:	May cause QTc prolongation.  Use the lesser of IBW or actual body weight (ABW).				Day 1	Perform every 1 day x1		Labs
  	CYTOMEGALOVIRUS ANTIGEN	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC > 1
		  	CYTOMEGALOVIRUS, QUANTITATIVE PCR	Interval: Every Mon, Thu	Occurrences: --	Comments:	Draw on Monday and Thursday if WBC < 1
		  	FK506 TACROLIMUS LEVEL, RANDOM	Interval: Every Mon, Wed, Fri	Occurrences: --			Line Care
  	sodium chloride 0.9% flush 20 mL	Dose: 20 mL	Route: intravenous	PRN	Start: S					Antiemetics
  	ondansetron (ZOFRAN) IV 10 mg	Dose: 10 mg	Route: intravenous	once for 1 dose	Start: S				  	promethazine (PHENERGAN) injection 25 mg	Dose: 25 mg	Route: intravenous	every 4 hours PRN	Start: S					Acute Graft Versus Host Prophylaxis
  	tacrolimus (PROGRAF) IVPB 0.02 mg/kg (Ideal)	Dose: 0.02 mg/kg	Route: intravenous	every 24 hours over 24 Hours	Start: S			Instructions:	May cause QTc prolongation.  Use the lesser of IBW or actual body weight (ABW).